银屑病甲损害与超声下远端指间关节改变的相关性分析  

Analysis of correlation between psoriatic nail involvement and changes of the distal interphalangeal joint under ultrasound

作　　者：林维茹 王秀环 李建可[1] 张兆光[3] 杨青[1] 刘国艳 LIN Weiru;WANG Xiuhuan;LI Jianke;ZHANG Zhaoguang;YANG Qing;LIU Guoyan(Shandong Provincial Hospital for Skin Diseases&Shandong Provincial Institute of Dermatology and Venereology,Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan 250022,China;Weifang Medical University,Weifang 261000,China;Affiliated Hospital of Weifang Medical University,Weifang 261000,China)

机构地区：[1]山东第一医科大学附属皮肤病医院(山东省皮肤病医院),山东省皮肤病性病防治研究所,济南250022 [2]潍坊医学院,潍坊261000 [3]潍坊医学院附属医院,潍坊261000

出　　处：《中国麻风皮肤病杂志》2022年第8期518-523,共6页China Journal of Leprosy and Skin Diseases

基　　金：济南市科技创新发展计划(临床医学科技创新计划)项目(编号:202134012)。

摘　　要：目的:分析银屑病患者甲损害与超声下远端指间关节改变的相关性。方法:纳入中重度寻常型银屑病(PsO)患者和关节病型银屑病(PsA)患者,记录患者的基本临床资料、甲损害特点以及超声下甲单元及远端指间关节情况。结果:研究共纳入中重度PsO患者38例,PsA患者35例。PsA组甲损害发生率高于中重度PsO组(85.7%vs 63.2%,P=0.028),前者mNAPSI评分(P=0.042)及甲板厚度(P<0.001)也高于后者。与中重度PsO组相比,PsA组附着点炎及骨赘形成的检出率高(77.1%vs 28.9%,P<0.001;74.3%vs 31.6%,P<0.001)。在中重度PsO患者的手指中,甲损害组指伸肌腱附着点炎及关节积液的发生率高于无甲损害组(11.4%vs 2.6%,P<0.001;35.6%vs 12.6%,P<0.001),在PsA患者的手指中,甲损害组指伸肌腱附着点炎、关节积液、滑膜炎、骨侵蚀、骨赘形成的发生率均高于无甲损害组(均P<0.05);所有患者同一手指水平mNAPSI评分、甲剥离、甲凹点均与指伸肌腱附着点炎相关,相关性最显著的是甲凹点(OR 2.02;95%CI 1.13~3.60)。结论:PsA患者更易出现临床甲受累,远端指间关节病变的患病率更高。指伸肌腱附着点炎的发生与mNAPSI评分、甲剥离、甲凹点显著相关。Objective:To analyze the correlation between nail involvement and ultrasound changes in the distal interphalangeal joint in patients with psoriasis.Methods:Patients with moderate to severe psoriasis vulgaris(PsO)and psoriatic arthritis(PsA)were enrolled,and their basic clinical data,characteristics of nail damage,nail unit and distal interphalangeal joint changes under ultrasound were recorded.Results:A total of 38 patients with moderate to severe PsO and 35 patients with PsA were included.The incidence of nail changes in PsA group was higher than that in moderate to severe PsO group(85.7%vs 63.2%,P=0.028),mNAPSI score in PsA group(P=0.042)and deck thickness(P<0.001)were also higher than that in PsO group.Compared with moderate to severe PsO group,PsA group had a higher detection rate of enthesopathy and osteophyte formation(77.1%vs 28.9%,P<0.001;74.3%vs 31.6%,P<0.001).In the fingers of patients with moderate to severe PsO,the incidence of extensor tendon enthesopathy and joint effusion was higher in the nail involvement group than in the fingers without nail involvement group(11.4%vs 2.6%,P<0.001;35.6%vs 12.6%,P<0.001).The incidence of finger extensor tendon enthesopathy,joint effusion,synovitis,bone erosion and osteophyte formation in PsA patients with nail involvement group was higher than that without nail involvement group(P;<0.05).On the same finger,the mNAPSI score,onycholysis and pitting were related to extensor tendon enthesopathy in all patients,especially the pitting with strong correlation.(OR 2.02;95%CI 1.13-3.60).Conclusion:Patients with PsA are more prone to nail involvement and enthesopathy at distal interphalangeal joint.The occurrence of extensor tendon enthesopathy is significantly related to mNAPSI score,onycholysis and pitting.

关 键 词：银屑病 甲损害 肌骨超声 关节改变 附着点炎 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]